Outline

Objective: The recurrence rate after microvascular decompression (MVD) in pharmacologically refractory trigeminal neuralgia (TGN) is 3-30%, and the annual recurrence rate at long-term follow-up ranges from 1 to 3.5%. The management of such patients is a challenge, and several options have been put forward. We evaluated the complication rate and outcome after second MVD.

Methods: 29 patients have been included in the study. Their medical documentation, surgical reports and videos have been evaluated, and the following parameters relevant for the study have been collected in a database: age at initial surgery and reoperation, sex, initial intraoperative findings, nature of inserted material, pain-free period, findings at reoperation, complication rate, and outcome. These parameters have been compared for the initial and second surgery.

Results: 13 patients were male and 16 female. Their mean age at reoperation was 53 years. The right side was involved more frequently (18/29). The mean period after initial surgery was 5.1 years. The comparison of the complications showed that the rate at reoperation was higher for: trigeminal hypoesthesia (from 6 to 15.3%), hearing loss (from 0.8 to 3.4%), and vertigo (from 0.3 to 3.4). The risk for CSF leak, facial nerve palsy, vascular complications, and mortality were not higher. 51% of the patients were pain-free after an average follow-up of 4.3 years.

Conclusions: The treatment of choice in case of recurrent TGN after previous MVD is a new MVD. It leads to good pain outcome in half of the patients at long-term follow-up and is not related to higher surgery-related complication risks.